Therapeutic exercises for emphysema. Exercise therapy and massage for emphysema, bronchial asthma, pulmonary tuberculosis Therapeutic exercises for emphysema

According to WHO, up to 4% of the population, mainly older men, suffer from emphysema (emphysao - “inflate”) - a pathological increase in lung volume. There are acute and chronic forms of pathology, as well as vicarious (focal, local) and diffuse emphysema. The disease occurs with impaired pulmonary ventilation and blood circulation in the respiratory system. Let's take a closer look at why emphysema appears, what it is and how to treat it.

What is pulmonary emphysema?

Emphysema of the lungs (from the Greek emphysema - swelling) is a pathological change in the lung tissue, characterized by its increased airiness, due to the expansion of the alveoli and the destruction of the alveolar walls.

Pulmonary emphysema is a pathological condition that often develops in a variety of bronchopulmonary processes and is extremely important in pulmonology. The risk of developing the disease in some categories is higher than in other people:

Congenital forms of pulmonary emphysema associated with a deficiency of whey protein are more often detected in residents of Northern Europe.
Men get sick more often. Emphysema is found at autopsy in 60% of men and 30% of women.
People who smoke are 15 times more likely to develop emphysema. Passive smoking is also dangerous.

Without treatment, changes in the lungs with emphysema can lead to disability and disability.

Causes leading to the development of emphysema

The likelihood of developing emphysema increases with the presence of the following factors:

congenital deficiency of α-1 antitrypsin, leading to the destruction of alveolar lung tissue by proteolytic enzymes;
inhalation of tobacco smoke, toxic substances and pollutants;
violations of microcirculation in the tissues of the lungs;
bronchial asthma and chronic obstructive pulmonary diseases;
inflammatory processes in the respiratory bronchi and alveoli;
features of professional activity associated with a constant increase in air pressure in the bronchi and alveolar tissue.

Under the influence of these factors, there is damage to the elastic tissue of the lungs, a decrease and loss of its ability to fill and collapse.

Emphysema can be considered as a professionally conditioned pathology. Often it is diagnosed in people who inhale various aerosols. The role of the etiological factor can be pulmonectomy (removal of one lung) or trauma. In children, the cause may lie in frequent inflammatory diseases of the lung tissue (pneumonia).

Mechanism of lung damage in emphysema:

Stretching of the bronchioles and alveoli - their size doubles.
Smooth muscles are stretched, and the walls of blood vessels become thinner. The capillaries become empty and nutrition in the acinus is disturbed.
Elastic fibers degenerate. In this case, the walls between the alveoli are destroyed and cavities are formed.
The area in which gas exchange between air and blood is reduced. The body is deficient in oxygen.
Expanded areas squeeze healthy lung tissue, which further disrupts the ventilation function of the lungs. Shortness of breath and other symptoms of emphysema appear.
To compensate and improve the respiratory function of the lungs, the respiratory muscles are actively involved.
The load on the pulmonary circulation increases - the vessels of the lungs overflow with blood. This causes disturbances in the work of the right heart.

Types of disease

There are the following types of emphysema:

Alveolar - caused by an increase in the volume of the alveoli;
Interstitial - develops as a result of the penetration of air particles into the interlobular connective tissue - interstitium;
Idiopathic or primary emphysema occurs without previous respiratory disease;
Obstructive or secondary emphysema is a complication of chronic obstructive bronchitis.

By the nature of the flow:

Acute. It can be caused by significant physical exertion, an attack of bronchial asthma, or the ingress of a foreign object into the bronchial network. There is swelling of the lung and hyperextension of the alveoli. The condition of acute emphysema is reversible, but requires emergency treatment.
Chronic emphysema. Changes in the lungs occur gradually, at an early stage, a complete cure can be achieved. Left untreated, it leads to disability.

According to anatomical features, there are:

Panacinar (vesicular, hypertrophic) form. It is diagnosed in patients with severe emphysema. There is no inflammation, there is respiratory failure.
Centrilobular shape. Due to the expansion of the lumen of the bronchi and alveoli, an inflammatory process develops, mucus is secreted in large quantities.
Periacinar (parasepital, distal, perilobular) form. Develops with tuberculosis. It can result in a complication - rupture of the affected area of the lung (pneumothorax).
Peripheral form. It is characterized by minor symptoms, manifests itself near fibrous foci and scars in the lungs.
Instantional (subcutaneous) form. Due to the rupture of the alveoli, air bubbles form under the skin.
Bullous (bubbly) form. Near the pleura or throughout the parenchyma, bullae (bubbles) with a diameter of 0.5-20 cm are formed. They occur at the site of damaged alveoli. They can rupture, become infected, and compress surrounding tissues. Bullous emphysema, as a rule, develops as a result of loss of tissue elasticity. Treatment of emphysema begins with the elimination of the causes that provoke the disease.

Symptoms of emphysema

The symptoms of emphysema are numerous. Most of them are not specific and can be observed in other pathologies of the respiratory system. Subjective signs of emphysema include:

unproductive cough;
expiratory dyspnea;
the appearance of dry wheezing;
feeling of lack of air;
weight loss
a person has a strong and sudden pain syndrome in one of the halves of the chest or behind the sternum;
tachycardia is observed when the rhythm of the heart muscle is disturbed with a lack of air.

Patients with emphysema mainly complain of shortness of breath and cough. Shortness of breath, gradually increasing, reflects the degree of respiratory failure. At first, it happens only with physical exertion, then it appears while walking, especially in cold, damp weather, and sharply increases after coughing attacks - the patient cannot "breathe". Shortness of breath with emphysema is unstable, changeable (“it doesn’t happen day after day”) - today it’s stronger, tomorrow it’s weaker.

A characteristic sign of emphysema is weight loss. This is due to the fatigue of the respiratory muscles, which work at full strength to facilitate exhalation. A pronounced decrease in body weight is an unfavorable sign of the development of the disease.

Noteworthy is the cyanotic color of the skin and mucous membranes, as well as a characteristic change in the fingers of the type of drumsticks.

People with chronic long-term emphysema of the lung develop external signs of the disease:

short neck;
expanded in the anteroposterior size (barrel-shaped) chest;
supraclavicular fossae protrude;
on inspiration, the intercostal spaces are drawn in due to the tension of the respiratory muscles;
the abdomen is somewhat saggy as a result of the omission of the diaphragm.

Complications

The lack of oxygen in the blood and the unproductive increase in lung volume affect the entire body, but above all, the heart and nervous system.

An increased load on the heart is also a compensation reaction - the desire of the body to pump more blood due to tissue hypoxia.
Perhaps the occurrence of arrhythmias, acquired heart defects, ischemic disease - a symptom complex, known under the general name "cardiopulmonary insufficiency".
At the extreme stages of the disease, a lack of oxygen causes damage to nerve cells in the brain, which is manifested by a decrease in intelligence, sleep disturbance, and mental pathologies.

Diagnosis of the disease

At the first symptoms or suspicion of emphysema, the patient is examined by a pulmonologist or therapist. It is difficult to determine the presence of emphysema in the early stages. Often, patients go to the doctor already in the running process.

Diagnostics includes:

blood test to diagnose emphysema
detailed interview with the patient;
examination of the skin and chest;
percussion and auscultation of the lungs;
determination of the boundaries of the heart;
spirometry;
survey radiography;
CT or MRI;
assessment of the gas composition of the blood.

X-ray examination of the chest organs is of great importance for the diagnosis of pulmonary emphysema. At the same time, expanded cavities are detected in various parts of the lungs. In addition, an increase in lung volume is determined, indirect evidence of which is the low position of the dome of the diaphragm and its flattening. Computed tomography also allows you to diagnose cavities in the lungs, as well as their increased airiness.

How to treat emphysema

There are no specific treatment programs for pulmonary emphysema, and those carried out do not differ significantly from those recommended in the group of patients with chronic obstructive pulmonary diseases.

In the treatment program for patients with emphysema, general measures that improve the quality of life of patients should come first.

The treatment of pulmonary emphysema pursues the following tasks:

elimination of the main symptoms of the disease;
improvement of the work of the heart;
improvement of bronchial patency;
ensuring normal blood oxygen saturation.

To alleviate acute conditions, drug therapy is used:

Eufillin to relieve an attack of shortness of breath. The drug is administered intravenously and relieves shortness of breath within a few minutes.
Prednisolone as a strong anti-inflammatory agent.
With mild or moderate respiratory failure, oxygen inhalations are used. However, here it is necessary to carefully select the concentration of oxygen, because this can both be beneficial and harmful.

All patients with emphysema are shown physical programs, especially chest massage, breathing exercises and teaching the patient kinesitherapy.

Is hospitalization required to treat emphysema? In most cases, patients with emphysema are treated at home. It is enough to take medication according to the scheme, stick to a diet and follow the doctor's recommendations.

Indications for hospitalization:

a sharp increase in symptoms (shortness of breath at rest, severe weakness)
the appearance of new signs of the disease (cyanosis, hemoptysis)
ineffectiveness of the prescribed treatment (symptoms do not decrease, peak flow measurements worsen)
severe comorbidities
newly developed arrhythmias difficulty in establishing a diagnosis.

Emphysema has a favorable prognosis under the following conditions:

Prevention of lung infections;
Refusal of bad habits (smoking);
Ensuring a balanced diet;
Life in a clean air environment;
Sensitivity to drugs from the group of bronchodilators.

Breathing exercises

In the treatment of emphysema, it is recommended to regularly carry out various breathing exercises in order to improve the exchange of oxygen in the lung cavity. The patient follows for 10 - 15 minutes. inhale the air deeply, then try to hold it as long as possible while exhaling with a gradual exhalation. This procedure is recommended to be carried out daily, at least 3 - 4 r. per day, in small sessions.

Massage for emphysema

Massage promotes sputum discharge and expansion of the bronchi. Classical, segmental and acupressure massage is used. It is believed that acupressure has the most pronounced bronchodilator effect. Massage objective:

prevent further development of the process;
normalize respiratory function;
reduce (eliminate) tissue hypoxia, cough;
improve local ventilation of the lungs, metabolism and sleep of the patient.

exercise therapy

With emphysema, the respiratory muscles are in constant tone, so they quickly get tired. To prevent muscle strain, physiotherapy exercises have a good effect.

Oxygen inhalations

A long procedure (up to 18 hours in a row) of breathing through an oxygen mask. In severe cases, oxygen-helium mixtures are used.

Surgical treatment of emphysema

Surgical treatment of emphysema is not often required. It is necessary in the case when the lesions are significant and drug treatment does not reduce the symptoms of the disease. Indications for surgery:

Multiple bullae (more than a third of the chest area);
severe shortness of breath;
Complications of the disease: oncological process, bloody sputum, infection.
Frequent hospitalizations;
The transition of the disease to a severe form.

A contraindication to the operation may be severe exhaustion, old age, chest deformity, asthma, pneumonia, in severe form.

Food

Compliance with the rational use of food in the treatment of emphysema plays an important role. It is recommended to eat as many fresh fruits and vegetables as possible, which contain a large amount of vitamins and trace elements useful for the body. Patients need to adhere to the use of low-calorie foods so as not to provoke a significant load on the functioning of the respiratory system.

Daily daily calorie content should not exceed more than 800 - 1000 kcal.

Fried and fatty foods that negatively affect the functioning of internal organs and systems should be excluded from the daily diet. It is recommended to increase the amount of fluid consumed to 1-1.5 liters. in a day.

In any case, you can not treat the disease yourself. If you suspect that you or your relative has pulmonary emphysema, you should immediately contact a specialist for timely diagnosis and treatment.

Forecast of life with emphysema

A complete cure for emphysema is impossible. A feature of the disease is its constant progression, even during treatment. With timely access to medical care and compliance with therapeutic measures, the disease can be somewhat slowed down, improve the quality of life, and also delay disability. With the development of emphysema against the background of a congenital defect of the enzyme system, the prognosis is usually unfavorable.

Even if the patient is given the most unfavorable prognosis due to the severity of the disease, he will still be able to live at least 12 months from the moment of diagnosis.

The duration of the patient's existence after diagnosing the disease is largely influenced by the following factors:

The general condition of the patient's body.
The emergence and development of such systemic ailments as bronchial asthma, chronic bronchitis, tuberculosis.
How the patient lives plays a big role. He leads an active mode of existence or he has low mobility. He observes a rational diet or eats food haphazardly.
An important role is given to the age of the patient: young people live longer after diagnosis than older people with the same severity of the disease.
If the disease has genetic roots, then the prognosis of life expectancy with pulmonary emphysema is determined by heredity.

Despite the fact that with emphysema, irreversible processes occur, the quality of life of patients can be improved by constantly using inhaled drugs.

Prevention

Anti-tobacco programs aimed at preventing children and adolescents from smoking, as well as at stopping smoking of people of any age, are of great preventive importance.
It is also necessary to treat lung diseases in time so that they do not become chronic.
It is important to observe patients with chronic respiratory diseases by a pulmonologist, conduct vaccines among the population, etc.

With chronic bronchitis, bronchial asthma, pneumoconiosis, pneumosclerosis, etc., emphysema often develops. Bronchospasm, impaired drainage function of the bronchi and impaired diffusion of gases are prerequisites for the development of the destruction process - atrophy and disappearance of the interalveolar septa, swelling of the alveoli. A decrease in the alveolar respiratory area leads to hypoxia and respiratory failure, and later to cardiopulmonary failure.

Physiotherapy, due to the irreversible nature of structural changes in the lungs, is intended to combat chronic infection, bronchospasm and hypersecretion, to improve the functional reserves of breathing. The main methods of physiotherapy are thermal, aerosol and climatotherapeutic procedures, regularly combined with breathing exercises.

In the initial bronchitis stage, when shortness of breath appears only with physical effort, a complex drug (antibiotics, sulfonamides) and physical therapy is used to overcome the infection in the bronchi: radiant heat, electrophoresis of iodine or calcium bilaterally on the chest, inhalation of local antibiotics, as with chronic bronchitis.

With exacerbations, treatment with UV rays, thermal and other procedures is also used. Inhalations of fine aerosols, electroaerosols or light negative air ions are suitable for stopping the phenomena of bronchial obstruction and for improving ventilation. With severe hypoxia, aerosol inhalations are carried out in a dispersed medium of oxygen instead of air, or oxygen inhalations are prescribed.

To mobilize the respiratory reserves, improve ventilation and gas exchange, it is most important to carry out breathing exercises, systemically, for 1-2 months. Breathing exercises should have a pronounced training character. Thanks to them, patients learn to breathe correctly and efficiently with a long exhalation. Emphasis is placed on exercises with an extended exhalation to increase respiratory excursions and strengthen the expiratory respiratory muscles. A chest massage is also recommended.

In the second stage, with permanent respiratory failure, thermal procedures, inhalations and other procedures are used, as in the first stage. However, there is an increased need for medical rehabilitation, carried out through special breathing exercises; controlled breathing during physical effort according to Livingston and Reid, diaphragmatic breathing, expansion of the lateral parts of the chest, exhalation with compression of the chest, etc.

It is recommended to breathe in a pressure chamber at an atmospheric pressure of 0.1-0.3 atm, daily, for an hour. Some experts recommend the use of pneumatic breathing with the help of special equipment, the so-called pneumotherapy, which facilitates exhalation and eliminates bronchospasm. At the moment of exhalation, the patient is provided with an air environment with reduced pressure (rarefied atmosphere), and when inhaling, an environment with normal or elevated pressure is provided.

In severe hypoxemia (blood oxygen saturation below 80%), intermittent (intermittent) oxygen therapy is used, for example, in an oxygen tent, however, it contains impure (100%) oxygen, due to the risk of incidents (paralysis of the respiratory center), and oxygen mixtures at a concentration oxygen 30-40-50%.

In the third stage - with cardiopulmonary insufficiency, physiotherapeutic procedures are not indicated.

Spa treatment. It is indicated for patients in the first and second stages. With this disease, resorts with a dry warm climate, as well as medium-high mountain resorts, are recommended.

Pulmonary emphysema is a chronic disease in which the alveoli expand, accompanied by atrophy and rupture of the interalveolar septa, a decrease in the elasticity of the lung tissue and a decrease in the respiratory surface, a decrease in the vital capacity of the lungs and the development of respiratory failure. With emphysema, the chest, as it were, freezes in the inhalation phase and gradually acquires a barrel-shaped shape. Excursion of the chest and diaphragm is reduced. Intercostal spaces widen. With emphysema, the patient has shortness of breath, cough, cyanosis of the lips, cheeks, hands. Exhalation is sharply weakened. The patient is unable to blow out the flame of a candle or match. Pulmonary emphysema is often a consequence of chronic bronchitis, pneumosclerosis, bronchial asthma. In the cold season, pulmonary emphysema worsens. Prevention of the disease consists in the timely and targeted treatment of diseases leading to emphysema. In the treatment of the disease, the patient is prescribed theofedrine, ephedrine, expectorants, smoking is prohibited. With exacerbation of chronic pneumonia or bronchitis, antibiotics, sulfonamides are prescribed. In the complex treatment of patients with pulmonary emphysema, massage is used. Massage is most effective in the initial stages of the disease. At the beginning of the disease, you can apply a general massage of light or medium intensity. In this case, the main attention is paid to the chest and abdominal muscles. All massage techniques are applied with a small pressure force of the massage therapist's hands. The purpose of the massage: the fight against the residual effects of bronchitis, pneumonia, strengthening the body, strengthening the respiratory muscles. The duration of the procedure with a general massage is 30-40 minutes. With severe emphysema and pulmonary insufficiency, chest massage is used from all sides. Use light tricks. Massage starts from the back of the chest:
1. Planar surface stroking.
2. Alternate rubbing with the capture of the lateral surfaces of the chest, neck and shoulder girdle.
3. Ironing (second option) simultaneously with both hands from the bottom up and laterally to the axillary lymph nodes and to the shoulder joints.
4. Sawing on the same surface.
5. Stroking in two rounds.
6. Spiral rubbing with four fingers simultaneously of both hands from the bottom up and laterally.
7. Ironing (second option).
8. Light patting.
9. Planar surface stroking. After that, they begin to massage the anterolateral surface of the chest:
1. Stroking in two rounds.
2. Alternate rubbing.
3. Ironing (second option).
4. Spiral rubbing with four fingers simultaneously of both hands.
5. Separate-consecutive stroking. In addition, it is necessary to massage the intercostal muscles on both sides of the chest:
1. Rake-like stroking forward or backward from the sternum to the spine.
2. Light spiral rubbing.
3. Rake-like stroking. When performing a massage of the anterolateral surface of the chest in the initial position of the patient lying on his back with stroking in two rounds, when the massage therapist's hands move in the opposite direction, the massage therapist squeezes the patient's chest with both hands at the moment of exhalation. When the masseur's hands move from bottom to top, the patient takes a breath. The speed of movement of the massage therapist's hands must correspond to the patient's breathing speed. This technique cannot be performed with the patient in a sitting position. In the latter case, it is replaced by chest compressions, as described in the massage technique for bronchial asthma. The duration of the procedure is 15-20 minutes daily. With emphysema of the lungs with symptoms of cardiopulmonary insufficiency, mainly the upper and lower extremities are massaged. They are used for embracing continuous stroking, alternate rubbing, spiral rubbing with four fingers, felting, semicircular kneading, longitudinal continuous kneading. The purpose of the massage: the fight against the phenomena of cardiopulmonary insufficiency, the improvement of peripheral and pulmonary circulation, the unloading of the pulmonary circulation, the fight against congestion. The duration of the procedure is 15-20 minutes daily. The course - 15-20 procedures is repeated regularly in one to one and a half months.

Contraindications for massage in respiratory diseases: acute inflammatory diseases of the respiratory system, active pulmonary tuberculosis, malignant and benign tumors, hemoptysis.

With the disease, the chest, as it were, freezes in the inhalation phase and gradually acquires a barrel-shaped shape. Excursion of the chest and diaphragm decreases, the intercostal spaces expand. The patient has shortness of breath, cough, cyanosis of the lips, cheeks, hands, exhalation is so weak that he cannot blow out the flame of a candle or match. Pulmonary emphysema is often a consequence of chronic bronchitis, pneumosclerosis, bronchial asthma, and in the cold season is exacerbated.

Prevention consists in the timely and targeted treatment of diseases leading to emphysema. The patient is prescribed medication (smoking is contraindicated).

In the complex treatment of pulmonary emphysema, massage is used, which is most effective in the initial stages of the disease.

At the onset of the disease you can apply a general massage of light or medium intensity, paying special attention to the massage of the chest and abdominal muscles. All massage techniques are applied with a small pressure force of the massage therapist's hands.

The purpose of the massage: fight against the residual effects of bronchitis, pneumonia, strengthening the body and respiratory muscles.

The duration of the procedure with a general massage is 30-40 minutes.

With severe emphysema and pulmonary insufficiency apply a light massage of the chest from all sides.

An approximate scheme and content of a massage procedure for emphysema

Back chest massage

1. Planar surface stroking.

2. Alternate rubbing with the capture of the lateral surfaces of the chest, neck and shoulder girdle.

3. Ironing (option 2) simultaneously with both hands from the bottom up and laterally to the axillary lymph nodes and shoulder joints.

4. Sawing on the same surface.

5. Stroking in two rounds.

6. Spiral rubbing with four fingers simultaneously with both hands from the bottom up and laterally.

7. Ironing (option 2).

8. Light patting.

9. Planar surface stroking.

Massage of the anterolateral surface of the chest

1. Stroking in two rounds.

2. Alternate rubbing.

3. Ironing (option 2).

4. Spiral rubbing with four fingers simultaneously with two hands.

5. Separate-consecutive stroking.

Massage the intercostal muscles on both sides of the chest

1. Rake-like stroking forward or backward from the sternum to the spine.

2. Light spiral rubbing.

3. Rake-like stroking.

When stroking the anterolateral surface of the chest in two rounds in the initial position of the patient lying on his back, when the massage therapist's hands move in the opposite direction, the massage therapist squeezes the chest with both hands at the moment of exhalation. When the masseur's hands move from bottom to top, the patient takes a breath. The speed of movement of the hands must correspond to the speed of the patient's breathing. This technique is not possible in the sitting position of the patient, so it is replaced by the chest compression technique (see above 1.5 ).

The duration of the chest massage procedure is 15-20 minutes. Massage is used daily.

With emphysema of the lungs with symptoms of cardiopulmonary insufficiency massage mainly the upper and lower limbs. They are used for embracing continuous stroking, alternate rubbing, spiral rubbing with four fingers, felting, semicircular kneading, longitudinal continuous kneading.

The purpose of the massage: fight against the phenomena of cardiopulmonary insufficiency and congestion, improvement of peripheral and pulmonary circulation, unloading of the pulmonary circulation.

The duration of the massage procedure is 15-20 minutes. Massage is performed daily.

The massage course consists of an average of 15-20 procedures and is repeated regularly every 1-1.5 months.

Massage for respiratory diseases Svetlana (Snezhana) Nikolaevna Chabanenko

Emphysema

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This disease is very serious, as it affects all respiratory organs. This, in turn, often leads to a general immobility of the chest.

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